IRON deficiency in children without anaemia: a method in diagnosis

Abstract

Iron deficiency anaemia in children is commonly encountered in paediatric institutions. It is easily diagnosed from the morphology of erythrocytes, provided that the haemoglobin value is below 10.0 g. /lo0 ml. The recognition of developing iron deficiency anaemia in the absence of low haemoglobin values is a continuous and challenging problem. It is well known that serum iron studies, bone marrow iron, and the determination of absolute indices are usually not helpful in such cases. With this in mind, a method was developed to provide more information about impending or overt iron deficiency in children aged between 6 mth. and 3 yr. A fragiligraph was used in a study of haematologically normal children and another group with blood films showing excessive microcytosis and hypochromia, with and without anaemia. Two systems of analysis were used. In the first, samples of blood diluted with saline were haemolyzed by dialysing them against a distilled water gradient for a set period of time. In the second series of experiments, identical samples were tested against buffered 0.2% saline. In both instances, use was made of continuous recordings showing point-to-point lysis of cells at specified time intervals. The results indicate that significant microcytosis may be recognized, even without anaemia, under the second set of experimental conditions. The test is rapid, reproducible and requires only a single drop of blood. It is capable of being performed by means of any photo-electric recording instrument (for instance standard haemoglobinometers) which has had home-made modifications. It was suggested that this test would be particularly suitable for field studies of iron deficiency anaemia.